16 May 2005

Serves me right?

I've been bewailing the fate of good ordinary Americans at the hands of the system, quite loudly. This started with the Terri Schiavo fiasco, when her husband miraculously remembered her right to die only after winning a huge pay out for her long term care and shacking up with a new woman.

Its all come back to bite me on the butt, and if you want to send up three cheers, be my guest.But then read this, a case in the UK, courtesy of the BBC:

Appeal over right-to-life ruling

A Court of Appeal hearing over whether doctors have the right to withdraw life-prolonging treatment is to start.

Leslie Burke, who has a degenerative brain condition, won a landmark ruling last year to stop doctors withdrawing food and drink when he cannot speak.

The 45-year-old feared General Medical Council rules on artificial nutrition may allow his wishes to be over-ruled.

In the original case, the judge said the rules should be redrafted, but the GMC said it wants clearer guidance.

Mr Burke, from Lancaster, who has cerebellar ataxia, took his case to court because he believed the GMC rules were incompatible with the European Convention on Human Rights, which enshrines the right to life.

RIGHT-TO-LIFE RULING

The original ruling said doctors could not withdraw artificial nutrition when a patient is unable to communicate and had earlier instructed them not to even if the doctors believe it is in their best interests

The GMC has appealed the verdict as artificial nutrition is classed as a treatment and it raises questions about medical intervention

The GMC also wants clearer guidance on what doctors should do if a patient has not left instructions

The GMC guidance covered situations where death is not imminent, but doctors believe a patient's condition is so severe, and their prognosis so poor, that artificial nutrition or hydration - giving water - causes more suffering than benefit.

It said that if patients are no longer able to communicate their views, doctors must judge what the patient would want, taking earlier instructions into account, but not relying on them altogether.

But Mr Justice Munby ruled last July that Mr Burke had the right to have artificial nutrition continued even when it comes to the point where he cannot communicate as that is his wish at the moment.

Judge

Since the ruling, the GMC has told doctors to adhere to the judge's verdict.

But it is appealing the decision as officials believe it is unclear how the judgement applies to other forms of treatment - artificial nutrition is classified as treatment under the council's guidance - that may be keeping a patient alive, such as antibiotics, or respiratory intervention.

They also want to clarify on what basis a doctor can withdraw treatment if a patient has not given any instruction.

Ruth Evans, chairman of the GMC's standards and ethics committee, said: "Some patients will want everything possible to be done, while others will want to avoid too much medical intervention, when they are nearing the end of life.

"Doctors want clear guidance to help ensure individual patients receive the care that's right for them."

But Roger Goss, co-director of Patient Concern, which will also be represented at the hearing, said it was wrong to class artificial nutrition as treatment.

"Feeding someone through a tube because they cannot swallow is not treatment, and should not be treated as such. Doctors should not have the right to take this away against a patient's wishes."